Organization Of Health Care System Research Articles

THE WAY THE HEALTH CARE SYSTEM IN UKRAINE LOOKS LIKE: INTERNATIONAL PRACTICES WITHIN NATIONAL REALITIES

Introduction: Nowadays there is the transformation of the national health care system in Ukraine, the ultimate goal of which is to create a modern, competitive model of medical care of citizens on the basis of forming packages of free medical services. However, the model adopted by Ukraine is in contradiction with national legislation in part of free medical aid guaranteed by the Art. 49 of the Constitution of Ukraine, and fragmentary considers positive international practices. The aim of the paper is to determine the mistakes of the reform of the Ukrainian health care system and to reveal the positive international practices of the organization of health care systems that can be implemented in Ukraine. Materials and methods: National and international legislation, official web resources of the executive authorities of Ukraine, statistics of the World Health Organization, materials of journalistic and scientific periodicals are the materials for the research of the health care system in Ukraine in comparison with international practices. Research methods are cross-sectoral, complex statistical, comparative, generalization, analysis and synthesis. In order to obtain the results, the authors have conducted a critical analysis of the current norms of the national Ukrainian legislation in the health care sector. Review: The authors of the article have studied the main disadvantages of the national health care system in accordance with the concept of reforming the medical sector. Positive international practices that can be implemented into Ukrainian system for the real improvement of medical human rights in Ukraine have been revealed. Conclusions: It has been proved that the ongoing reform of the health care system in Ukraine needs to be reviewed and optimized. It has been offered to consolidate a perspective model of the Ukrainian health care system, its principles and guarantees of immunity at the legislative level.

An investigation of the effect of accessibility to General Practitioner services on healthcare utilisation among older people

Equity in access to healthcare services is regarded as an important policy goal in the organisation of modern healthcare systems. Physical accessibility to healthcare services is recognised as a key component of access. Older people are more frequent and intensive users of healthcare, but reduced mobility and poorer access to transport may negatively influence patterns of utilisation. We investigate the extent to which supply-side factors in primary healthcare are associated with utilisation of General Practitioner (GP) services for over 50s in Ireland. We explore the effect of network distance on GP visits, and two novel access variables: an estimate of the number of addresses the nearest GP serves, and the number of providers within walking distance of a person's home. The results indicate that geographic accessibility to GP services does not in general explain differences in the utilisation of GP services in Ireland. However, we find that the effect of the number of GPs is significant for those who can exercise choice in selecting a GP, i.e., those without public health insurance. For these individuals, the number of GPs within walking distance exerts a positive and significant effect on the utilisation of GP services.

Short Stay Thyroid Surgery: Can We Replicate the Same in Low Resource Setting?

Introduction The concept of short stay thyroidectomy has been tested and in practice in the developed world; the same has not been replicated in countries with limited resources due to lack of organized healthcare system. So, in this study, we tried to analyze if short stay thyroid surgery can be performed in a cost-effective way in developing countries and also if the endocrine surgical trainee can deliver these services safely. Methods The study was conducted prospectively from January 2013 to July 2014, at Department of Endocrine Surgery, SGPGIMS, Lucknow, India. Study group included patients undergoing short stay hemithyroidectomy whereas matched patients who qualified for inclusion criteria but did not undergo short stay surgery due to various reasons constituted control group. Outcome in both the groups was compared in terms of complication rates, cost benefit, and patient satisfaction. Subgroup analysis was also done for trainee versus consultant performed short stay thyroid surgery. Results A total of 439 patients with surgical thyroid disorders were evaluated at our institute during the study period and out of these 110 patients (58 cases and 52 controls) fulfilled the inclusion criteria. Younger patients with low socioeconomic status who were paying out of pocket were found to be more inclined to short stay thyroid surgery. There was no significant difference between the two groups in terms of postanesthetic discharge score (PADS), complication rates, and patients satisfaction; however there was significant reduction (p <0.001) in hospital cost in short stay group. In subgroup analysis, procedure time was more in trainee performed surgeries; however there was no significant difference in terms of mean PADS and complication rates. Conclusion Short stay thyroidectomy can provide a better cost-effective alternative to conventional thyroidectomy in patients undergoing thyroid surgery and can be safely performed by endocrine surgical trainees even in a low resource setting.

Health Services Utilization in Asthma Exacerbations and PM10 Levels in Rural Colorado.

The San Luis Valley in rural Colorado often has elevated levels of ambient particulate matter. To date little is known about the impact of ambient particulate matter levels and medical care utilization due to asthma exacerbation in rural communities. We investigated the impact of ambient particulate matter concentrations on emergency/urgent visits and hospitalizations for asthma in a rural community. Daily ambient particulate matter concentrations from an air quality monitor in the San Luis Valley (2003-2012) were obtained from the state health department. Deidentified data for emergency/urgent visits with a diagnosis code for asthma were collected from the local health care system organization. A generalized linear model using splines and employing generalized estimating equations for correlated measures over time was used to examine the association between daily counts of emergency/urgent visits for asthma and 3- to 5-day averaged ambient particulate matter concentrations. For each 15-μg/m3 increase in 3-day averaged ambient particulate matter, there was an associated 3.1% increase in hospital counts for all patients with asthma (95% confidence interval, 0.3-5.9%; P = 0.03). When the 3-day average exceeded 50 μg/m3, asthma hospital visits increased by 16.8% (P = 0.03), and when it exceeded 100 μg/m3, visits increased by 65.8% (P = 0.002). In children, the odds of one asthma event requiring an emergency/urgent care visit increased 5.0% with each 15-μg/m3 increase in 3-day averaged ambient particulate matter (P = 0.22). We observed associations between ambient air levels of particulate matter with a diameter less than 10 μm and emergency/urgent care visits and hospitalization counts in a rural U.S. community prone to dust storms and Environmental Protection Agency exceedances.

O cuidado das condições crônicas na atenção primária à saúde

O cuidado das condições crônicas na atenção primária à saúde

CLINICAL TRIAL RESULS AND REAL WORLD MEDICAL EVIDENCE GAP

This is a systematic literature overview concerning contemporary approaches to the gap between randomized clinical trials (RCT) results and the evidence within real world medical practice («efficacy-effectiveness gap, EEG»). The overview includes 18 articles and 1 publication by regulatory expert community. 13 articles describe the EEG using particular evidence and 5 articles discuss the issue systematically. According to the results of the observations, the authors of 16 articles concluded that this discrepancy exists, and the authors of 2 articles concluded that in their studies this discrepancy was not found. Upon current review it was concluded that the factors providing EEG can be divided into the following groups: subjective factors coming from healthcare system organization processes and the caregiver-patient intercommunication principles; objective factors coming from essential RCT limitations as a scientific method; and the artificial limitations always made within RCT taking intermediate position.

Veterans’ Care: The Author Replies

Letters Health AffairsVol. 37, No. 4: Culture Of Health, The ACA & More Veterans’ Care: The Author RepliesRisha Gidwani-Marszowski AffiliationsVA Health Economics Resource Center Menlo Park, CaliforniaPUBLISHED:April 2018Free Accesshttps://doi.org/10.1377/hlthaff.2018.0106AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSVeterans healthQuality of careMarketsMedicareGovernment programs and policiesClinical practiceHospital carePublic healthOrganization of careMy colleagues and I agree with William Weeks that markets matter and there is often variation in quality of care across locations. We controlled for this variation in our study (Jan 2018) using a fixed effect for geographic region (see the article’s online appendix for further explanation of the use and interpretation of this effect).1 Thus, our work identifies the highest-performing system within a particular market. On average, across the country, the Department of Veterans Affairs (VA) provides higher-quality care than Medicare.Weeks suggests the VA should design programs encouraging veterans to use the highest-quality health care within a region. We support the development of such programs.On a broader note, Weeks states that outcomes for veterans would be better if they used high-quality community care, citing his own study in support. However, our work as well as systematic literature reviews provide evidence to the contrary: The VA provides similar- or higher-quality care than the private sector.2 Furthermore, Weeks’s paper notes that due to a lack of risk adjustment, “no conclusions should be drawn regarding the relative performance of VHA and the private sector from this analysis.”3VA-to-Medicare comparisons provide important information about how health care system organization and financing affect quality of care. In the case of end-of-life cancer care, after adjusting for market characteristics, the VA outperforms Medicare.NOTES1 To access the original article’s appendix, click on the Details tab of the article online. Gidwani-Marszowski R, Needleman J, Mor V, Faricy-Anderson K, Boothroyd DB, Hsin Get al. Quality of end-of-life care is higher in the VA compared to care paid for by traditional Medicare. Health Aff (Millwood). 2018;37(1):95–103. Go to the article, Google Scholar 2 Trivedi AN, Matula S, Miake-Lye I, Glassman PA, Shekelle P, Asch S. Systematic review: comparison of the quality of medical care in Veterans Affairs and non–Veterans Affairs settings. Med Care. 2011;49(1):76–88. Crossref, Medline, Google Scholar 3 Weeks WB, West AN, Wallace AE, Lee RE, Goodman DC, Dimick JBet al. Reducing avoidable deaths among veterans: directing private-sector surgical care to high-performance hospitals. Am J Public Health 2007;97(12):2190–1. Crossref, Google Scholar Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 2 April 2018 Information© 2018 Project HOPE—The People-to-People Health Foundation, Inc.PDF download

Comparative Analysis of the Key Factors Influencing Healthcare Systems of OECD Countries

Abstract The Health sector, as a part of the national economy, is extremely important for economic development. A well organized and operating healthcare system constitutes an important notion for both patients and national policy. That is why the organisation of healthcare systems is the subject of reform in many countries. The aim of this study is to identify homogeneous groups of countries from the OECD in terms of the level of delivery of medical services. Countries considered in the study will be analysed through the prism of selected characteristics. The results of the study will form the basis for international comparisons and application of solutions used by countries with better healthcare systems. The study will be backed up by a chosen multivariate statistical analysis — cluster analysis.

Identification of conditions which lead to unjustified requests for emergency treatment of hypertensive patients.

Aim To determine most common factors making patients with high blood pressure seek professionally unacceptable treatment of hypertension at the Emergency Department. Methods The survey was conducted at the Emergency Department of the Primary Health Care in Gradačac on randomly selected 207 patients who requested medical help because of high blood pressure. For all patients arterial blood pressure and body mass index (BMI) were measured. A survey about knowledge and attitudes regarding habits that affect high blood pressure as well as the socio-economic conditions was made. Results Prevalence of 10.3% was found with regard to visits to emergency care by patients due to high blood pressure. Most patients, 127(61.4 %), were overweight and 36(17.4%) were obese. Patients who rarely controlled their blood pressure were more frequent visitors of emergency medical services. Stressful situation occurs as a factor in a variety of forms. The survey showed that 76 (36.7%) patients sought medical help even though they had no blood pressure values that required emergency care. Conclusion Poorly organized health care system with no continuous and comprehensive preventive promotional programs caused by inappropriate use of resources in health care. The reorganization of primary care with full implementation of family medicine and greater integration of family medicine with other levels of the health care system should provide a better control and treatment of other diseases such as hypertension.

Perceived barriers to access available health services among men who have sex with men in Dar es Salaam, Tanzania

Background: Men who have sex with men (MSM) continue to be highly affected with the HIV infection worldwide. Studies have shown that the organization of healthcare systems and how the MSM perceive it play a major role in granting or denying them access to healthcare services. Little is known in Tanzania regarding the barriers that MSM face while accessing health services within the country. The study was geared towards determining the proportion of MSM who accessed health care and disclose their sexual orientations to health care workers (HCW). It also intended to find out the anticipated barriers from HCW’s if they were to disclose their sexual orientations to them and consider the types of social networks used when facing various challenges. Methods: The study employed both quantitative and qualitative methods. Participants were enrolled in the study Respondent Driven Sampling. Quantitative data was entered and analysed using the Statistical Package for the Social Sciences v.20. Qualitative data was collected using in-depth interviews read and interpreted to identify themes and create categories. These were manually analysed and interpreted according to the study objectives. Results : The majority (87.7%) of MSM accessed healthcare services when sick, only a few (3.4%) did nothing due to lack of financial resources. Only a third of them had ever disclosed their sexual orientations to healthcare workers. This was due to lack of confidentiality, fear of stigma and discrimination, shame and mistreatment at the health facilities, and fear of the healthcare worker’s reaction after they disclosed their sexual orientation to them. Conclusion : MSM need to be empowered to overcome their perceived fears towards healthcare workers and health facilities. Efforts should be put into breaking the cycle of negative information and perceptions MSM have about healthcare workers and how they deal with same sex practices’ health related problems.

Abstract P481: Key Findings From Multilevel Stakeholder Input On Awareness, Gaps And Needs Related To The Burden Of Hypertension

Background: Hypertension (HTN) continues to pose a considerable challenge to the health system. Suboptimal rates of screening, awareness, treatment and control, reported at national and local levels, reflect an urgent need for a coordinated and collective approach to action. Methods: On May 20, 2017 (World HTN day), we convened a one-day HTN summit in response to an expressed need from stakeholders across the health system (healthcare, public health, community organizations) in the Bi-State Greater Kansas City Area. To help formulate an action plan, we administered a pre-and post-survey to document stakeholder engagement in HTN programs, their awareness of existing key initiates and resources, and perceived needs to address HTN. Results: Overall, 24 individuals from 16 organizations registered for the event and completed a pre-event survey - healthcare system (46%), Public health or Government organizations (17%), Community organizations (29%), Academic entity (8.3). Thirteen (54%) attendees completed the post-event survey - 29% delivered healthcare services, 57% conducted community activities, 21% were patients or caregivers. Only 32% of the attendees reported a current program on blood pressure. Less than 10% of participants reported satisfaction with the availability of regularly scheduled learning opportunities or tools for healthcare professionals or patients to improve HTN. Only 21% of participants reported monitoring of performance on metrics related to high blood pressure programs. All attendees expressed interest in continued meetings, patient engagement resources, and an in-depth exploration of the underlying factors contributing to the burden of uncontrolled HTN. Findings also reflected a significant need to improve the awareness of resources like the Missouri Million Hearts initiative and Target BP™. Conclusion: In spite of temporal advancements in cardiovascular medicine, there exist significant gaps in the awareness and use of resources and tools to support HTN management among stakeholders in the health system. Planned strategies include a dedicated working group to proactively identify and support coordinated, multi-stakeholder efforts to reduce the HTN burden and improve cardiovascular health in our communities.

Coordenação do cuidado e ordenação nas redes de atenção pela Atenção Primária à Saúde – uma proposta de itens para avaliação destes atributos

Introdução: A formação de redes de atenção à saúde (RAS) tem se mostrado como uma forma de organização de sistemas de saúde eficaz para responder a alguns dos atuais desafios epidemiológicos e estruturais destes sistemas. O Brasil vem caminhando para a regionalização e a conformação de redes de atenção à saúde. A fim de avaliar o desenvolvimento das RAS, propõe-se um conjunto de itens para inferir dois dos atributos das redes: a coordenação do cuidado individual e a ordenação das RAS pela Atenção Primária à Saúde. Métodos: Utilizou-se o Método Delphi, composto pelas seguintes etapas: definição inicial dos itens a serem avaliados e composição do grupo de experts, realização de quatro rodadas do Delphi e avaliação dos resultados. Resultados: O produto final foi uma lista de 69 itens, destes, 59 questões atingiram estabilidade de opinião entre os experts e podem ser divididas em: um grupo de 44 itens que atingiram grau de consenso alto entre os experts para inclusão do item na lista final; um grupo de 12 itens que atingiram grau de consenso intermediário; e um grupo de 3 itens que atingiram grau de consenso baixo. A construção desta proposta de itens para avaliação das RAS tem por intuito central colaborar com as pesquisas relacionadas às avaliações sistêmicas dos serviços de saúde.

Viral hepatitis C in Poland in the Silesian Province between 2005-2014.

Viral hepatitis C remains one of the major health and social problems related to infectious diseases in Poland. The aim of the study was assessment of the registered changes in the incidence of HCV in the Silesian Province of western Poland during the last 10 years, including age, gender and place of residence. A retrospective analysis was performed of the HCV incidence between 2005-2014 in the Silesian Province. The crude and standardized incidence rates were calculated for males and females in each year. Subsequently, the territorial diversity of the epidemiological situation in the districts was assessed by calculating the average incidence rate over the entire study period. Incidence rates calculated according to the case definition of 2005 ranged between 5.95/100000 in 2005 to 10.36/100000 in 2014. Analysis of the structure of the incidence showed that during the analyzed period, the majority of hepatitis C cases were related to males (52.5%) rather than females (47.5%), and hepatitis C was more prevalent in younger males (aged 20-49) and older females (aged over 50). After excluding the effect of age, the standardized rates were twice as low, compared to the crude incidence rates. An increase in the HCV incidence rate was observed in males and females. It is obvious that the detection of additional cases will entail the need to provide funding for the treatment of more patients, which should be included in the map of regional health needs in the coming years. Our study demonstrates the temporal and spatial variability of HCV incidence in the Silesian Province of Poland. The observed increase in the crude and standardized rates suggests that the current registry system of HCV in Poland is more effective now. The current situation is comparable with the data in other EU countries.

地域ケアシステム構築の方法論と保健婦の能力に関する研究 : その1-システム構築のために保健婦が用いた能力

地域ケアシステム構築の方法論と保健婦の能力に関する研究 : その1-システム構築のために保健婦が用いた能力

Increasing healthcare costs: can we influence the costs of glaucoma care?

Despite a decrease in real average growth rates per capita since 2009, healthcare costs continue to rise worldwide. Numerous patient-related and doctor-related factors have contributed to this rise. Glaucoma is the leading cause of irreversible blindness and requires chronic, usually lifelong treatment. As with other chronic diseases, the adherence to prescribed treatment is often low and maybe influenced by the cost of the therapy. The purpose of this review is to seek potential solutions to best control the escalating costs of glaucoma care. The studies we selected for this review can be divided into four different categories: costs of diagnostic tests; costs of direct comparisons between drugs or laser and conventional surgery; patient-related factors (such as adherence); and general aspects regarding costs: theoretical models and calculations. It is challenging to find reliable studies concerning this subject matter. As patients are under the umbrellas of variously organized healthcare systems which span different cultures, the costs between countries are difficult to compare. However, one common aspect to lower costs in glaucoma care is to improve patient adherence. Theoretical models with actual patient studies could enable cost reductions by comparing multiple diagnostic and therapeutic scenarios. VIDEO ABSTRACT: http://links.lww.com/COOP/A22.

Rehabilitation Services Provision and Payment.

Persons with spinal cord injury (SCI) experience disability and have significant need for rehabilitation. To deliver appropriate rehabilitation, interventions and programs suitable services must exist. A prerequisite for system improvement is a description of rehabilitation services. The aim of this paper was to develop a rehabilitation service framework for SCI. Additionally, principles and models of payment of rehabilitation services will be discussed. Health-related rehabilitation services should be available along the continuum of care and implemented at all levels of health care. The three most important types of services are acute, postacute, and long-term rehabilitation services. Health-related rehabilitation services for patients with SCI must be able to provide high-quality equipment and a well-trained, highly specialized and multiprofessional team of rehabilitation workers. The principles of payment for SCI rehabilitation services vary according to the organization of health care systems, which primarily depends on the sources of money (eg, from national health care systems, other health insurances, or out of pocket). Funding systems and payment criteria may influence service provision and justice in service delivery. It is important to analyze the provision of rehabilitation services and the related funding system using uniform assessment and evaluation tools.

Vaccination coverage and factors associated with adherence to the vaccination schedule in young children of a rural area in Burkina Faso

ABSTRACT Background: Vaccination is an important tool for reducing infectious disease morbidity and mortality. In the past, less than 80% of children 12–23 months of age were fully immunized in Burkina Faso. Objectives: To describe coverage and assess factors associated with adherence to the vaccination schedule in rural area Burkina Faso. Methods: The study population was extracted from the Nouna Health and Demographic surveillance system cohort. Data from four rounds of interviews conducted between November 2012 and June 2014 were considered. This study included 4016 children aged 12–23 months. We assessed the effects of several background factors, including sex, factors reflecting access to health care (residence, place of birth), and maternal factors (age, education, marital status), on being fully immunized defined as having received Bacillus Calmette–Guérin (BCG), three doses of diphtheria–tetanus–pertussis and oral polio vaccine, and measles vaccine by 12 months of age. The associations were studied using binomial regression to derive prevalence ratios (PRs) in univariate and multivariate regression models. Results: The full vaccination coverage increased significantly over time (72% in 2012, 79% in 2013, and 81% in 2014, p = 0.003), and the coverage was significantly lower in urban than in rural areas (PR 0.84; 0.80–0.89). Vaccination coverage was neither influenced by sex nor influenced by place of birth or by maternal factors. Conclusion: The study documented a further improvement in full vaccination coverage in Burkina Faso in recent years and better vaccination coverage in rural than in urban areas. The organization of healthcare systems with systematic outreach activities in the rural areas may explain the difference between rural and urban areas.

Unplanned Extubations in Intensive Care Unit: evidences for risk factors. A literature review.

Background and aim: Unplanned extubations (UE) are getting more and more relevant in Critical Care, becoming a quality and care safeness outcome. This happens because after an UE the patient can face some complications concerning the airway management, respiratory and hemodynamic problems, lengthen in the hospital stay and in the mechanical ventilation time. The aim of this review is identify and classify the factors that could increase UE risk. Methodology: A systematic review of scientific articles was performed consulting the databases PubMed, Cinahl, Medline, EBSCOhost and Google Scholar. Articles from 2006 to 2011 were included. Pediatric Care settings were excluded. Results: 21 articles were selected. From the results emerged that risk factors associated to the patient are widely controversial. Yet restlessness, a low level of sedation and a high level of consciousness seem to be highly related to UE. Organizational risk factors, as workload, nurse:patient ratio, and the use of interdisciplinary protocols seem to play an important role in UE. Conclusion: According the current literature, the research on UE still has to handle a wide uncertainty. There is the need for more studies developing conclusive evidences on the role of different risk factors. Anyway, literature highlights the importance of the nurse and of the healthcare system organization in reducing UE incidence.

Integrated care network for long term care in Portugal: cost estimation and patient’s characteristics

Background: Portugal began the implementation of an integrated care network for Long Term Care (LTCIN) in 2006. Its main objective is to deliver services of health and social support including post-acute and long term care. There are four different types of inpatient LTC units: Palliative Care Units (PCU), Convalescent Care Units (CCU), Medium Stay and Rehabilitation Care Units (MSRCU) and Long-Stay and Maintenance Care Units (LSMCU) (1). These units are financed both by the Ministry of Health and the Ministry of Social Affairs.In 2014 LTC represented roughly 0.1% of Portuguese GDP. Despite the rapid growth verified (in 2014 the available beds were ten times higher than in 2006), LTC resource allocation was still far from 1% of GDP verified in developed countries such as Australia, UK or Germany (2, 3, 4).The growing demand for LTC, the increase need of public funding, budget constraints and fourth age demographic pressure triggered the need for rethinking the structure of care provision (5). The knowledge of analytical costs per episode and the specific factors that influence cost variation is a relevant issue to the development of alternative ways for resource allocation.Purpose: The main objective of this study was to estimate LTC episode costs and assess their association to patient characteristics and inpatient unit types.Methods: A cross sectional retrospective study was conducted. Data was collected from LTCIN information system including administrative inpatient data (gender and age), physical autonomy and cognitive status of patients from 2010 to 2012. Cost Information (Balance Sheets and Profit and Loss Statement) was provided voluntarily by seventeen LTC providers. To meet the purpose of the analysis we included inpatient episodes only and excluded palliative care units due to organizational issues.Submitted financial data allowed the estimation of costs of 1.856 distinct episodes, roughly 4.1% of all inpatient LTC episodes reported within the timeframe.A top-down cost accounting method was adopted and average per diem cost was estimated for each provider. Each episode cost was achieved multiplying the per diem cost by the LOS of the specific episode.In order to assess the association between costs and patient characteristic and provider type a Multiple Linear Regression (MLR) analysis with stepwise variable adoption approach was performed and the following formula was adopted:Model 1: Cost i=β_0+β_1 〖Gender〗_i+β_2 〖Age〗_i+β_3 〖PhisicalAutonomy〗_i+β_4 〖CognitiveStatus〗_i+〖β_5 〖ProviderType〗_i+u〗_iTo isolate the effect of patient characteristic per se the same method was used in Model 2 excluding the variable provider type.Results: Per diem average cost of each inpatient episode was 84.28€. Costs differ according to type of unit considered; CCU (96,85€); (MSRCU) (84,84€); LSMCU (67,85€).Results from Model 1 shows that provider type is relevant for explaining cost variation. MSRCU has average per diem costs more than two times higher than CCU. Cognitive status is not relevant for explaining cost variation except for patients with poor cognitive status which have smaller average per diem costs. Results from Model 2 show that even when we exclude provider type patients’ characteristics remain not relevant for explaining cost variation.Discussion: Provider type is the most relevant variable for explaining cost variation. This suggests that supply characteristics are more relevant than considered demand characteristics to define resource allocation and costs. The referral to specific type of provider according to treatment plan seems to drive the cost and, according to it, patients with similar characteristics may represent different per diem LTC costs.During the study we found some limitations. The most relevant is the absence of detailed cost information and complete diagnosis data. We used the best information available (Balance Sheet and Profit &amp; Loss Statement), which are the legal economic documents imposed by the fiscal system. We recognize that the adoption of standardized minimum dataset of financial elements for LTC providers or bottom-up patient costing method (recommended solution), would allow us a better cleaner picture on what is relevant for explaining cost variation.Despite limitations and recognizing that different results could be found if different methods were adopted, we believe in our study’s relevance. As far as we know It is the first study in Portugal that aims explaining LTC cost variation at episode level, , reinforces the need for the adoption of a robust cost accounting method and concludes that further research is required.Conclusion: The subject LTC is receiving increasing attention because of demographic trends and the pressures on public finances. Identifying the factors that may influence costs is a relevant issue to inform decision makers on resource allocation planning and ultimately to ensure that healthcare system organization does not promote negative externalities such as access barriers, moral hazard behaviours or resource allocation inequity.

The Cancer Research Network: a platform for epidemiologic and health services research on cancer prevention, care, and outcomes in large, stable populations.

The ability to collect data on patients for long periods prior to, during, and after a cancer diagnosis is critical for studies of cancer etiology, prevention, treatment, outcomes, and costs. We describe such data capacities within the Cancer Research Network (CRN), a cooperative agreement between the National Cancer Institute (NCI) and organized health care systems across the United States. Data were extracted from each CRN site's virtual data warehouse using a centrally written and locally executed program. We computed the percent of patients continuously enrolled ≥1, ≥5, and ≥10years before cancer diagnosis in 2012-2015 (year varied by CRN site). To describe retention after diagnosis, we computed the cumulative percentages enrolled, deceased, and disenrolled each year after the diagnosis for patients diagnosed in 2000. Approximately 8 million people were enrolled in ten CRN health plans on December 31, 2014 or 2015 (year varied by CRN site). Among more than 30,000 recent cancer diagnoses, 70% were enrolled for ≥5years and 56% for ≥10years before diagnosis. Among 25,274 cancers diagnosed in 2000, 28% were still enrolled in 2010, 45% had died, and 27% had disenrolled from CRN health systems. Health plan enrollment before cancer diagnosis was generally long in the CRN, and the proportion of patients lost to follow-up after diagnosis was low. With long enrollment histories among cancer patients pre-diagnosis and low post-diagnosis disenrollment, the CRN provides an excellent platform for epidemiologic and health services research on cancer incidence, outcomes, and costs.